Claim Date* *

Type of Product *

Customer Details

Name *

Phone *

Email *

Purchase Date * *

Purchase From: *

Model * *

Frame / Serial *

Speedometer (Km) *

The kilometers can be found on the display of your scooter or bike

PARTS AFFECTED

Comment Please provide as much information as you can. It will help us to asses the problem and provide a quick solution for you. Asnwers like how, what, where, when the problem arised are also useful to identify the main issue.

PHOTO’S MANUFACTURER REQUIREMENT 1 *

Please take a picture of the error or faulty part. Also take a picture of your whole scooter or bike

PHOTO’S MANUFACTURER REQUIREMENT 2 (OPTIONAL)

Please take a picture of the error or faulty part. Also take a picture of your whole scooter or bike

PHOTO’S MANUFACTURER REQUIREMENT 3 (OPTIONAL)

Please take a picture of the error or faulty part. Also take a picture of your whole scooter or bike

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

WARRANTY FORM

Customer Details

PARTS AFFECTED

Thanks for getting in touch!

Thanks for getting in touch!

Christmas Discount

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